Aortic Arch Pseudoaneurysm with Porcelain Aortic Arch and Triple-Vessel Coronary Artery Disease: Single-Stage Total Arch Replacement with Coronary Artery Bypass Grafting

Porcelain aortic arch with coronary artery disease poses a major surgical challenge. We report a 66-year-old man with a large arch pseudoaneurysm, circumferential arch calcification, left common carotid artery thrombosis, and triple-vessel coronary disease who underwent single-stage total arch replacement with coronary artery bypass grafting. Surgery utilized axillary and femoral cannulation, hypothermic circulatory arrest, and selective antegrade cerebral perfusion. Complete recovery followed a transient postoperative neurological deficit, demonstrating feasibility of tailored open repair.